Insulin Sensitivity Measured with the Oral Minimal Model is lower in Obese Subjects Who Report omitting their Breakfast

Introduction: Omitting the breakfast has been reported to promote weight gain and to impair insulin sensitivity. However this latter effect was only assessed with simple surrogates. We thus aimed at verifying if insulin sensitivity is lowered in individuals who omit their breakfast with a more quantitative assessment, using the “Oral Minimal Model” (OMM) i.e., an extension of Bergman’s minimal model to oral glucose tolerance-tests, in a cross-sectional study of a population exhibiting the full range of body mass indices.Materials and methods: We selected on our database of patients, explored for weight and/or eating disorders, 27 individuals omitting their breakfast (defined on the basis of an alimentary standardized questionnaire) and compared them to 103 matched subjects taking a hyperglucidic breakfast. The breakfast was analyzed with the OMM for the assessment of insulin sensitivity. Insulin secretion was assessed with a previously reported procedure, allowing the calculation of the parameters of phase 1 and 2 of insulin secretion of Cobelli and Mari’s models. In addition, it is already known that Mari’s model provides an index of post stimulatory potentiation of insulin secretion. Disposition indices (product of SI and insulin secretion parameters) were also determined.Results: In the 27 subjects omitting their breakfast compared to the 103 matched subjects the difference in insulin sensitivity was not found. No difference in insulin secretion parameters is detected. Homeostasis between insulin secretion and insulin sensitivity appears to be functional. However when splitting the sample in categories of BMI the expected difference appears in the range 30-40. In this subgroup (Omitting (n=9) BMI: 35.4±0.99 vs. non-omitting (n=47) BMI: 34.1±0.37 kg/m²) insulin sensitivity was lower in individuals omitting their breakfast (4.32 10-4 min-1/(μU/ml)± 0.94 vs. 9.33±1.84, p=0.03). Despite a slight increase in insulin levels and in the overall insulin secretion rate, a decrease in potentiation and in disposition index was evidenced in individuals omitting their breakfast. The lowering effect of omitting the breakfast on insulin sensitivity is thus evidenced in obese subjects in this sample (but not in those with a BMI below 30). This impairment in insulin sensitivity resulted in a decrease of glucose tolerance by 34%. This finding, based on a cross-sectional study but using a sophisticated measurement, is in agreement with the previous report that omission of the breakfast may induce resistance to insulin. It suggests that the worsening effect on SI that was experimentally found in an interventional study in healthy women becomes important enough in obese subjects to be detected in a cross-sectional study, and that this effect associates a decrease in SI and an incomplete adaptation of insulin release to this reduction in SI, and thus a decrease in glucose tolerance.

Supporting on-going Diabetes Management: The Need for Frequent, Reliable Information, Decision Support and Guidance to Empower People with Diabetes

As noted by the World Health Organization (WHO) diabetes is a silent epidemic, and by 2020 there will be a 54% rise in the total number of individuals diagnosed with this disease. Moreover, diabetes is the most prevalent chronic disease globally today. What these figures underscore is that the current approaches to prevention and management of diabetes appear to be flawed and thus not delivering the desired results. While it is well recognized that early detection and proactive management of diabetes is essential, this paper suggests a technology solution to assist a key patient frustration around diet and meal planning; namely a solution that can frequently provide reliable information, decision support and guidance to empower people with type 2 diabetes.

Brown Adipose Tissue Remodeling Precedes Cardiometabolic Abnormalities Independent of Overweight in Fructose-Fed Mice

Background: Body fat distribution is a risk factor for several health conditions, although the literature shows that excess body fat is not always associated with cardiometabolic abnormalities in all subjects.Objectives: To investigate glucose, lipid, and hepatic metabolism, along with white (WAT) and brown adipose tissue (BAT) remodeling in a mice model of short-term fructose feeding.Methods: Male C57BL/6 mice (n = 10-11/group) were fed for four weeks with control diet (AIN93-M) or experimental diets rich in glucose or fructose. We investigated body weight, body adiposity, blood glucose, lipid and hepatic parameters, and WAT and BAT histopathology.Results: Fructose feeding did not promote either weight gain or adipocyte hypertrophy of visceral and subcutaneous WAT depots, but the fat was redistributed toward visceral depots. Fructose-fed mice did not show glucose, lipid, and hepatic metabolic dysfunction, except for an elevation in total cholesterol and hepatic weight. BAT mass did not increase, and it was proportionally reduced compared with visceral WAT in fructose feed mice. BAT suffered early adverse morphological remodeling, characterized by increased lipid deposition and enlargement of intracellular lipid droplets.Conclusion: Short-term fructose feeding redistributes fat among WAT depots, alters the ratio between BAT andvisceral WAT, and promotes BAT adverse remodeling, characterized by enlarged intracellular lipid droplets.

Maternal Exercise Uncovers Placental Insufficiency in Diabetic Mothers

Regular physical activity during pregnancy improves or maintains physical fitness, helps with weight management, reduces the risk of gestational diabetes, and enhances patient’s psychological well-being. We studied the possibility to use maternal exercise to test placental reserves in diabetic mothers. We used a motorized treadmill in a moderate exercise regimen (15-minute fast walk at a speed of 3 mph with an incline of 15-25 degrees). Fetal monitoring was provided by using standard Phillips equipment (Avalon CTS and FM40). Adverse fetal outcomes were considered if one or more of the following were present: Category III Fetal Heart Rate (FHR) tracing, 5-minute Apgar score of less than 7, admission to the neonatal intensive care nursery, fetal growth restriction, and fetal and early neonatal death. A total of 819 fetal assessments were performed: 160 patients had gestational diabetes, 80 had pregestational diabetes. The most common complication in fetuses with positive prenatal test results was abnormal FHR in labor (36%) followed by low Apgar score (21%) and need for NICU admission (19%). Most of the adverse outcomes had good correlation with positive results of the exercise test. In conclusion, it appears that maternal exercise causes changes in FHR, which may be used to assess placental and fetal reserves.

β-cell Related Amyloidosis Localized to the Islets of Langerhans, Type II Diabetes Mellitus and Liponecrotic Pancreatitis in Rheumatoid Arthritis: A Postmortem Clinicopathologic Statistical Study of 234 Autopsy Patients

The aim of this study was to determine the prevalence of systemic AA amyloidosis (AAa), islet amyloidosis (IA) and liponecrotic pancreatitis (LnP) including acute liponecrotic (aLnP), acute relapsing liponecrotic (aRelLnP), and chronic liponecrotic pancreatitis (chrLnP) in rheumatoid arthritis (RA), and to analyse the possible relationship between them.Patients and methods: At the National Institute of Rheumatology 11558 patients died between 1969 and 1998; among them 234 with RA, and all of them were autopsied. RA was confirmed clinically according to the criteria of the American College of Rheumatology (ACR). The diagnosis of DM was based on clinical data. Tissue samples of pancreas were available for histologic evaluation in 164 of 234 patients. AAa, IA and LnP were diagnosed histologically. Demographics of different patient cohorts were compared with the Student (Welch) t probe. The relationships between AAa and IA, furthermore between IA and DM or LnP (including aLnP, aRelLnP, chrLnP) were analyzed by Pearson’s chi-squared (c2) test.Results: AAa complicated RA in 42 (25.61%) of 164 patients. IA localized to the islets of Langerhans was observed in 16 (9.76%) of 164 pancreases. Clinically diagnosed DM was associated with RA in 31 (18.90%) of 164 patients. Pancreatitis with multiple liponecrotic foci (LnP) was found in 19 (11.58%) of 164 patients; aLnP existed in 9 (47.37%), aRelLnP in 4 (21.05%), and liponecrotic foci in combination with chronic fibrotic pancreatitis (chrLnP) in 6 (31.58%) of these 19 patients.Discussion and conclusions: There was no significant difference between female and male RA patients associated with AAa, IA, DM and LnP. The age, sex and onset of disease did not influence basically the prevalence of AAa, IA, DM and LnP except male patients with IA, whose mean age at death was significantly higher than the general RA population. IA (fibrillar amyloid IAPP deposits -AIAPP) is related to the activity of b cells and may presumably be a faulty product of b-cells (normal islets of Langerhans do not contain IA deposits). The progressive deposition of IAPP prohormon fragments inhibits the function of b-cells because of their toxic effect and/or blocking mechanically the blood supply of b-cells and they “die in their own product”. The significant correlation between IA and DM refers to a close connection between them, but not necessarily a direct cause and effect relationship; it may be an indirect result of damaged (apoptotic) b-cells. The early stage of IA is characterized by minimal IAPP deposits involving only a few islets, which represents a clinically latent DM, and the advanced stage of IA is characterized by massive IAPP deposits involving most of the islets, which correspond to clinically manifest DM. Based on the positive and significant correlation between IA and clinically not diagnosed DM, IA may be a good indicator of potential DM in the latent stage of disease. Therefore we recommend that all biopsy material and surgical specimens of pancreas to be tested for IA or IAPP deposition.

Gemigliptin in Diabetic Kidney Disease in Asian Indians with Type 2 Diabetes in Real-Life Scenarios- Insights from Gem Study

Diabetic Kidney disease is strongly associated with cardiovascular events, premature mortality and ESRD. Gemigliptin can be used without dose adjustment in patients with renal failure. The current study aimed to assess the possible renoprotective effects of gemigliptin, using albuminuria and eGFR as indicators. This was a multi-center real-world retrospective analysis of 146 DPP-4 inhibitor naïve type 2 diabetic patients with established moderate DKD (eGFR between 30 to 45 ml/min/1.73 m2 over last 3 months) with diabetic retinopathy who received gemigliptin 50 mg once daily for 24 weeks in addition to anti-hyperglycemic, anti hypertensive’s and statins. Goodness of fit was examined using SPSS statistics 20 and ANOVA was conducted to interpret the results. Baseline characteristics were: 71 (48.6%) males and 75 (51.4%) females, the mean age was 60.81 ± 7.42 years, mean duration was 11.92 ± 3.3 years, mean BMI was 26.54 ± 2.59 kg/m2. Gemigliptin showed significant improvements in glycaemia, renal and lipid parameters with no deterioration in retinopathy, liver enzymes and with no hypoglycemic episodes and was weight neutral. In the present study, gemigliptin reduced albuminuria independent of age, gender, duration of diabetes, Hba1c, eGFR and SBP. It could ameliorate diabetic nephropathy by reducing urine albumin excretion and mitigating the reduction of eGFR in diabetic patients.

Hyperglycemia in Rural Dwellers: A cross sectional study of the Effutu Municipality, Ghana

Background: Despite increasing prevalence of hyperglycemia leading to a type 2 diabetes mellitus (T2DM) in the urban areas, relatively little is known about its actual prevalence and associations in the rural population. This study sought to determine hyperglycemia and its associated risk factors among rural dwellers in the Effutu Municipality.Method: A simple-random cross-sectional study was conducted from January 2015 to May 2015 at the Effutu Municipality, in the Central region of Ghana. One hundred and forty-nine (149) participants were enrolled onto the study. A structured questionnaire was administered to obtain information on demography, alcohol use, tobacco use, educational status, visual challenges, sugary food intake and late-night eating. Blood samples were obtained for determination of fasting blood glucose (FBG). Body mass index (BMI), waist to hip ratio (WHR) and waist circumference (WC) were determined and hip circumference (HC) using standard protocols. Data obtained was analyzed with Statistical Package for Social Sciences (SPSS) and p < 0.05 was considered statistically significant.Results: The study showed 8.1% hyperglycemia among the rural dwellers and advanced age showed significant association with glycemic status (P = 0.0376). BMI, gender, waist hip ratio, waist circumference and hip circumference were higher in hyperglycemic participants than in normogylcaemic participants, however there was no significant difference when these parameters were compared by glycemic status.Conclusion: The prevalence of hyperglycemia in rural dwellers was 8.1% and it was significantly associated with advanced age. BMI, gender, HC, WC, WHR showed no association with hyperglycaemia.

Physician and Patient Attitudes Toward Screening for Kidney Complications in Type 2 Diabetes: Is There A Role for Patient Self-Advocacy?

Urine protein screening rates among patients with type 2 diabetes are suboptimal despite evidence supporting its efficacy in preventing or slowing the progression of diabetic kidney disease (DKD) [1]. Testing of untimed urine specimens to quantify albumin (urine albumin-creatinine, or uACR)-the recommended screening test based on combination of simplicity, cost, and cardiovascular and renal prognostic value-is particularly underutilized, despite longitudinal efforts to improve awareness and screening among physicians [2].

Obesity in Children and Adolescents and the Factors Responsible for it: A Case Study among Children of Some Affluent Families

The present analysis is based on data regarding the level of obesity amongst 662 children and adolescents of 560 families. These were the families of students of American International University – Bangladesh. The children and adolescents were classified by the level of obesity which was measured by percentiles of BMI. It was observed, that among 662 children and adolescents 465 were in the underweight group. Obesity and severe obesity were observed among 9.1% children and adolescents. Among the obese and severe obesity group, 53.3% killed their time while watching television, which is not a scheduled healthy activity and another 26.7% utilized the time playing sports and games, which is a planned and scheduled healthy activity. Obesity and severe obesity were associated with killing time in doing unhealthy activity. Among the obese and severe obesity group of children 31.7% were diabetic patients. Diabetes and level of obesity were significantly associated [ = 8.75, p-value = 0.033]. Among obese and severe obese groups, around 42% were habituated in taking restaurant food and these two characteristics were also significantly associated with food habit of the children [ = 94, p-value = 0.000]. Some socioeconomic factors of parents, viz. parent’s education, father’s occupation, and income of the families were also associated with level of obesity. The logistic regression analysis showed that all the variables, except the variable mother’s occupation, were significantly related to the variation of the level of obesity of children. For underweight children family income had a significant impact on their level of obesity.

Homocysteine Levels Otherwise Display Cardiovascular Disease in Diabetes Mellitus

Patients suffering for Diabetes Mellitus (DM) have 2 to 6-fold increase of cardiovascular complications. On the other hand, serum increase of total plasma homocysteine (HHcy) is an emerging risk factor for Cardio-Vascular Disease (CVD). A stronger association between DM and HHcy exists, even through the underlying pathogenetic mechanism remains unexplained. Thus, patients contemporary having DM and HHcy have a prevalence of CVD, whereas in those without HHcy, metabolic symptoms often prevail on cardiovascular complications. The possible causes of higher incidence of CVD in DM and HHcy in comparison to DM without HHcy were examined. The different Resistin expression from adipocytes between DM with and without HHcy seems to unlikely influence the incidence of CVD. Concerning that, two different variants of DM may be identify: one, characterized by prevalent metabolic symptoms (dysmetabolic form) and another, characterized by early and massive atherosclerotic symptoms (cardiovascular form).